Combined Treatment of Aortic Diseases

The aorta starts from the heart and ends in the abdomen near belly button. Sometimes, the pathology of the aorta occurs in more than one location and due to more than one cause. Therefore, treatment planning is extremely vital to the patient’s safety. The general principle is to treat the part of the aorta nearer to the heart first, with treatment being performed on the site where rupture is going to occur, for which there are usually associated symptoms. Otherwise, the more enlarged section will be treated first.

 

Computer x-ray imagery reveals the entire pathology of the aorta, and treatment planning can possibly take place at the same time with treatment being administered all at once or at appropriate intervals.

In any case, some locations of the aorta can be treated by use of aortic replacement stent graft, while open surgery is the more suitable option for other locations. Hence, combining both treatment options  with a proper treatment order increases the safety of patients.

 

As an example, there is a patient who is 69 years of age who has experienced severe back pain accompanied by hypertension for over 10 years. Computer x-ray discovers dissection in the walls of the descending section of the aorta in the chest down to the abdomen, and it also discovers that the abdominal section of the aorta below the renal arteries has developed an aneurism of 5.3 centimeters in width. Because coronary angiography produces a normal result, and the patient has normal kidney function, the section of the aorta in the chest is treated first by use of aortic stent graft inserted via the  left femoral artery. As a result, the patient’s back pain symptoms improved. However, given the presence of severe abdominal pain, surgery is performed to replace a part of the aorta with an aortic replacement stent by use of open abdominal surgery.

 

The reason why aortic stent graft could not be used as treatment for the latter symptom is because the walls of the aorta below the kidneys experienced dissection that has divided the walls into 2 separate layers.

In any case, the surgery went well, and on the 3rd day after the initial treatment, the patient experienced good recovery and was discharged within 7 days after surgery. Then post-treatment computer x-ray showed signs of clotting in the walls of the aorta inside the chest and reduced risk of rupture. At the same time, blood supply to the various abdominal organs returned to normal, and abdominal pain disappeared after surgery. The treatment of complex aortic diseases caused by multiple abnormalities can be safely performed with good outcomes and few complications. Effective planning by combining both standard treatment methods and good treatment prioritization can reduce complications.